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STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER )A
r~ t~ J
ADDRESS i
SUBDIVISION / CSM# LOT ~
SECTION LJ T / N-R_,ZLW, Town of
ST. CROIX COUNTY, WISCONSIN
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
0b i
W
r~
vc-'
fiue~f ch S
INDICATE NORTH ARROW
E tv) Ito. C ~TW Tr eo
Provide sek an c1 1e tion information on reverse of this form.
Provide 2 dimensions to center of septic tank manhole cover.
• ,T
BENCHMARK: (r6 ~W F
p F-
7 L~
ALTERNATE BM:
PTIC TANK / PUMP C,H(AMBER HOLDING TANK INFORMATION
Manufacturer: 11~:~s C ~`('q4_~ ~ Liquid Capacity:le;G 16 56
f Setback from: Well House Other
Pump: Manufacturer C lltld NW Model# Size /
t~
Float seperation ,_t Gallons/cycle
Alarm Location
:SOIL ABSORPTION SYSTEM
c ~
Width: Length 10 Number of trenches
Distance & Direction to nearest prop. line: ( f 36Gt
r '
Setback from: well: House ~>:-~O Other
ELEVATIONS
Building Sewer ST Inlet. ST outlet
PC inlet PC bottom Pump Off
Header/Manifold Bottom of system
Existing Grade Final grade
DATE OF INSTALLATION.;
PLUMBER ON JOB:
LICENSE NUMBER: 3 a l
INSPECTOR:
3/93:jt
Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County:
~abw an4Hu,nan Relations INSPECTION REPORT ST. CROTX
Safety and Buildings Division
(ATTACH TO PERMIT) sanitayr PermitNO.:
GENERAL INFORMATION 792-too
Permit Holder's Name: ❑ City ❑ Village Town o : State Plan ID No.:
NONN, JAMES WARREN
CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.:
rc..o
TANK INFORMATION E EVATION DATA A9600213
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark ps'
Dosing GSCU .
Aeration Bldg. Sewer ~D- q0, `I9
Holding St/Ht Inlet yg'
TANK SETBACK INFORMATION St/ Ht Outlet
TANK TO P/ L WELL BLDG. Aiir intake ROAD Dt Inlet
Septic z , NA Dt -8040M Pa.1 g /
Dosing 7.2 0 , aI NA Header/ Man. w g`5S~
E Z~~
w q:-7-L qa.i
Aeration NA Dist. Pipe 6-110,69 Holding Bot. System la A' 40, 3a'
PUMP/ SIPHON INFORMATION Final Grade
Manufacturer Demand
Model Number o GPM
TDH Lift O$ Lriction mfg SystemaJ5 TDHg,31v Ft
Forcemain Length -~O' Di a. a a Dist. To Well S '
SOIL ABSORPTION SYSTEM
BED/TRENCH Width / Length i No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS DIMENSIONS
LEACHING Manu acturer:
SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM
INFORMATION Type O /1-3 CHAMBER Mode Number:
System: Zu" OR UNIT
DISTRIBUTION SYSTEM
Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
Length Dia. Length Dia. Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched
Bed /Trench Center Bed /Trench Edges " Topsoil E] Yes E] No E] Yes ❑ No
COMMENTS: (Include code discrepancies, persons presCent, etc.)
W !
CJ ~3L" /'`1_p Q s~j &4 e,&-&00~ - ado
Plan revision required? ❑ Yes ❑ No
Use other side for additional information. 9 I- 9~ O Wz~, Q4qaezk~ I ~ J .2 Ird SBD-6710 (R 05/91) Date In e r ignature Cert. No
ADDITIONAL COMMENTS AND SKETCH
a ' T
SANITARY PERMIT NUMBER:
E
SANITARY PERMIT APPLICATION COUNTY
v'■~-■'■■~ In accord with ILHR 83.05, Wis. Adm. Code
Giro,
STATE SANITARY PERMIT #
-Attach complete plans (to the county copy only) for the system, on paper not less than 1:1 ~g 4 L
8% x 11 inches in size. Ch rf revision to previous application
-See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER
1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION.
PROPER OWNER PROPERTY LOCATION
6K Ft/4 S o10 T 09A R E (Dr0
PROPERTY _O ~ 'S IvaAILIN Ak 1(4 DDR n LOT # 3 BLOCK #
otuQ l/~ Gl /jam. ~t--.►
CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER 51y) a
)d o65 s'o5ya2
I( )
II. PE OF BUILDING: (Check one CITY T EAREST ROAD /
❑ State Owned VILLAGE Q e(/~ l~
❑ Public 1 or 2 Fam. Dwelling-# of bedrooms PAR EL TAX WEI`(S) I `
Ill. BUILDING USE: (If building type is public, check all that apply) V Cri 10 7 A.
1 ❑ Apt/Condo v [ C!
2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility
3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining
4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/Car Wash
5 ❑ Hotel/Motel 90 Office/Factory 13 ❑ Other: Specify
IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable)
A) 1. ~ New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an
System System . Tank Only Existing System Existing System
B) ❑ A Sanitary Permit was previously issued. Permit # Date Issued
V. TYPE OF SYSTEM: (Check only one)
Non-Pressurized Distribution Pressurized Distribution Experimental Other
11 ❑ Seepage Bed ?1 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank
12 El Seepage Trench x~b 22 ❑ In-Ground 42 ❑ Pit Privy
13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy
14 ❑ System-In-Fill
VI. ABSORPTION SYSTEM INFORMATION:
1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE
REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/dayp/sq. ft.) (Min./inch) ~-b 3U ELEVATIQL~
Feet 9a,, 9D g~~Fe7et
VII TANK CAPACITY Site
in allons Total # of Prefab. Fiber- Exper. Con- INFORMATION New xisting Gallons Tanks Manufacturer's Name Concrete strr cted Steel
glass Plastic App
Tanks Tanks
Se tic Tank or Holdin Tank a 0 (,7 C'S YC~(~ S Dz~ 1 0-- F1 F1 1 El F-1
Lift Pump Tank/Si hon Chamber
Vlll. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on t ched plans.
ps) MP/ r ess Phone Number:
Plumber' Name (Print): Plu s Signature: (N ?m
b S L ~ S p~SF
T
Plumber's Address (Street, City, State, rip Code :
wq U 41;t- yllcJ y- s r
IX. COUNTY/DEPARTMENT USE ONLY
DA ❑ Disapproved Saa itary Permit Fee (Includes Groundwater Date ue in gent Signatur (No Stamps)
`f' / ~ Surcharge Fee)
fAppro wed ❑ Owner Given Initial
Adverse Determination
X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL:
SBD-6398(R.08/93) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber
INSTRUCTIONS . ' z
1. A sanitary permit is valid for two (2) years.
2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new
criteria in the Wisconsin Administrative Code will be applicable.
3. All revisions to this permit must be approved by the permit issuing authority.
4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be
submitted to the county prior to installation.
5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed
pumper whenever necessary, usually every 2 to 3 years.
6. If you have questions concerning your onsite sewage system, contact your local code administrator or the
State of Wisconsin, Safety & Buildings Division, 608-266-3815.
To be complete and accurate this sanitary permit application must include:
1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of
where the system is to be installed.
ll. Type of building being served. Check only one and complete of bedrooms if 1 or 2 Family Dwelling.
III. Building use. If building type is Public, check all appropriate boxes that apply.
IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, reconnection, or
repair.
V. Type of system. Check appropriate box depending on system type.
VI. Absorption system information. Provide all information requested in ##1-7.
VII. Tank information. Fill in the capacity of every new and/or existing tank, list the total gallons, number of
tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all
septic, pump/siphon and holding tanks for this system. Check experimental approval only J tanks received
experimental product approval from DILHR.
VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g.
MP, etc.), address and phone number. Plumber must sign application form.
IX. County/Department Use Only.
X. County/Department Use Only.
Complete plans and specifications not smaller than 8% x 11 inches must be submitted to the county. The
plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of
holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service;
streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system
areas; and the location of the building served; B) horizontal and vertical elevation reference points;
C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump
a performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if
k required by the county; E) soil test data on a 115 form; and F) all sizing information.
t
GROUNDWATER SURCHARGE
i
1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of
regulated practices which can effect groundwater.
The monies collected through these surcharges are used for monitoring groundwater, ground-
water contamination investigations and establishment of standards.
SBD-6398 (R.11/88)
a
Z&sLf s
~ 331
AI S ~ see ~ 9 a 9~
a
~ to Sewe~ ~~S`t Be 95.vo
Row ~
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IoW
30
,~,=1"U~ 3D b~ /oqo
a-~X7bj revrC~e
87
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~,•hrt~ lbb,D Top P
6orner
PAGE OF
Z1- PUMP CHAMBER WEATHECROSSR PROOF SECTION AND SPECIFICATIONS
VENT AP
APPROVED LOCKIN
JUNCTION BOX MANHOLE COVER W
2S' FROM DOOR, I1)vr niin :.cabrl
WINDOW OR FRESH I="MIV. I
AIR INTAKE I
GRADE I ti "MIN.
ID"MIIJ.
CONDUIT
18"MIN.
I -
INLET PROVIDE
. AIRTIGHT SEAL
APPROVED JOINT A I I I APPROVED JOINTS
W/C.I. PIPE I I l I W/C.I. PIPE
EXTENDING 3' I II ALARM EXTENDING 3'
ONTO SOLID SOIL
ONTO SOLID SOIL D I i 1
I I ON
c I l
I
ELEV. OFF
FT. PUMPS
~
D
CONCRETE BLOCK
RISER EXIT PERMUTED Ly dF TANK MAMUFACTURI~R HAS SUCH APPROVAL APPRov
~BEpOIN4
SEPTIC 6 S P E r -I F1 C AT 1011 S
005E
TAN KS MANUFACTURER: IJUMDER OF DOSES: PER DAy
~ •
TANK 51ZE : GALLOWS IDOSE YOLUME
NCLUDING OACKFLOW: GALLONS
ALARM MANUFACTURER: 740 k t
MODEL IJUMBER: CAPACITIES: A= o vn INCHES OR 353- ~ GALLONS
SWITCH TYPE: v 1 g = fir _INCHES Olt ~~GALLONS
PUMP MANUFACTURER: GD 1i ! C= 0.1 INCHES OR 1_ls2 GALLONS
MODEL NUMBER: D- INCHES OR 17117 r GALLONS
SWITCH TYPE: MOTE: PUMP AND ALARM ARE TO BE /I.OOq/ *rr.
MINIMUM DISCHARGE RATE a _GPM INSTALLED ON SEPARATE CIRCUITS J r
VERTICAL DIFFERENCE DETWECN PUMP OFF AND ,DISTRIBUTIOLI PIPE.. FEET
♦ MINIMUM NETWORK SUPPLY PRESSURE . . . . . . 2 5 FILET
♦ L VEET OF FORCE MAIN FYofxFRICT10L1 FACTOR.-&. FEET
TOTAL DtIWAMIC HEAD = '3 FEET
INTERNAL DIMLWSIOWS OF TAWK: LENGTH it
;WIDTH L.;LIQUID DEPTH
LICENSE NUMBER: w € DATE:
V
abor yn and Human tment of Relations Industry,
L SOIL AND SITE EVALUATION REPORT Page of 3
Labor
Division of Safety & Buildings in acc R 83.05, Wis. Adm. Code
COUNTY
Attach complete site plan on paper not less th x 11 inches an must include, but ST
not limited to vertical and horizontal refers (BM), diyetio nd 7fgq'f ' pe, scale or PARCEL I.D.
dimensioned, north arrow, and location a is nce ti,~ ar
APPLICANT INFORMATION-PLEAS INT AFL'°I*FQR 100""" A REVIEWED BY DATE
r
PROPERTY OWNER: "P OPERTY LOCATION
Dq R Y L• To K-,~ C-S y ~ OvT. LOT NE 1 /4 56 1/4,S20 T 2- N,R 18 E (or) W
,Vr
PROPERTY OWNER':S MAILING ADDRESS L
OT BLOCK # SUBD. NAME OR CSM #
I 12- G• o iC.. uE • a 3 GSiy Pz-,uviu G--
CITY, STATE ZIP CODE PHON&NUMBEA EpTY ❑VILLAGE F;IFMN NEAREST ROAD
R o RE'fe r-s w I . s 1402-3 (71.5) i/o )At. sr,
(-New Construction Use ( wr Residential / Number of bedrooms 3 1 o V_ (J Addition to existing building
j Replacement (j Public or commercial describe
Code derived daily flow gpd Recommended design loading rate • 7 bed, gpd/ft2 • trench, gpolff2
Absorption area required bed, ft2 trench, ft2 Maximum design loading rate • 7 bed, gpd/ft2 • 4?trench, gpd/ft2
Recommended infiltration surface elevation(s) S R+¢- . 3 ft (as referred to site plan benchmark)
Additional design / site considerations u S E" T E GCHQ $
Parent material SGS S9 - G/,4ci;.1 Flood plain elevation, if applicable A "/f 0
S = Suitable for system CONYENTIa MOUND IN_ G~NDD U PRESSURE AT-GRAPE SYSTEM IN FILL HOLDING TANiK,
U = Unsuitable fors stem [L7~$S El U F- lp U Cr}•S'~p U ❑ S 2t
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture structure consistence Boundary Roots GPD/tt•
...v_ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed -fl
o -~z /o y,, 2.12-
2 ~ w ~6 yR 3/ce f 5-A& 1` e CS 2 I y S
Ground 3 24 7/Q,
elev.
It
Depth to I
limiting
factor .i
> D l
Remarks:
Boring #
I o-iz /0m S/ Zit Sht 70 Woe cs 3 ~ .s: •C.,
3 /-3 /o Yle 3/z s/ / f sd,~ .,-f p cis • Y S
Ground
elev. -~j /o W y CS O, S . q7- q5 d ?
It.
Depth to
limiting
factor I
QKM IAL
Remarks:
CST Name:-Please Print D Q R T ?A L(3 IQ i C 1~T Phone: 715-- 3
Address:45S 0'Aje'1 ~D• I+VP4010 Ld.'I. 5Ltd)j& a,~ I4- ~4/ CaSr'9 Zy~Z.
PROPERTY OWNERZ~ SOIL DESCRIPTION REPORT Page L. of 3
PARCEL I.D. # 3
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boun 3y Roots GPD/ft
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed tends
3 !U -/0 /0 ~/Z 2 S,/ a~i2 CS
•S -G
z D -/s /0 3 ~Erry y
Ground 3 / v /o Yk 71te
elev. a
/00 . i0 ft.
Depth to _
limiting
factor „ F
i
Remarks:
Boring # D-/J- /p YR Z~Z S~ Z ShiC~ ~-vV74R C S 'S d-5
lo y s d, s eP,2 _ i• 00
Ground
elev.
17.3
Depth to
limiting
factor
Remarks:
Boring #
74
32- - 311
Ground 3 32- 10,Y4 3/(Q -f S6k- A cf k cs s -60
elev. y .7. . CS S - 7
97~Ic S y
Depth to
limiting
factor
> ~l
Remarks:
Boring #
Ground
elev.
fL
Depth to
limiting
factor
3 0 F 3 Tp
nor 3?9o -rp
zi 131q
~/~itTro,J
/d O• D
5 Y57-e-,41
s
83 yG '
13
\ F
~ N
I<MO t t "
M
0
~ v
SCALe : t 3 0
• l3~t~~tiac P,•rs
s ~
VC-,&EsTeP SYSTEM
wiscoNew arrt entof eu tryd. Closer to staked out homesite. ~0
Lab*)r,anWHe€ngn Relations SOIL AND SITE EVALUAT Page i of 3
Division of Safety and Buildings in accordance with s. ILHR 83.0
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must ounty
include, but not limited to: vertical and horizontal reference point (BM), direction and J u l Str , i
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. ~arcel I.%f
r $O
Date
APPLICANT INFORMATION - Please print all information. Ln_HGE
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)).
Property Owner Property Location W
James & Barb KNorn Govt. Lot NE 1/4 SE 1/4,S 20 T 29 ,N,R 18 E (or) W
Property Owner's Mailing Address Lot # Block# Subd. Name or CSM#
2875 Buck Run Rd. 3 ICSM 125427, Vo1.10, P9.2872
City State Zip Code Phone Number Nearest Road
Chippewa Fa is i.5472 (715 )723-0654 ❑city Village ® Town lloth St.
® New Construction Use: ® Residential / Number of bedrooms 3 - 4 Addition to existing building
❑ Replacement ❑ Public or commercial - Describe:
450-
Code derived daily flow 6 9 0 gpd Recommended design loading rate 7 bed, gpd/f?-.3-trench, gpd/112
Absorption area required 8 5 8 bed, ft2 750 _trench, ft 2 Maximum design loading rate . 7 bed, gpdfll . 8 trench, gpd/ft2
Recommended infiltration surface elevation(s) see P g - 3 ft (as referred to site plan benchmark)
Additional design/site considerations Atrni d bed Recommended- long trenches w~/ drop box- distr
Parent material Flood plain elevation, if applicable N/A ft
S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank
U= Unsuitable for system U S ❑ U ® S ❑ U ® s ❑ u W S ❑ u ®S ❑ U ❑ S O U
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Structure GPD/112
in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed , Trench
6 l organic loam lfsbk mfr. gs if .4 :.5
0-21 10YR/2a
Ground
elev F450-90 32_
. '
gravelly
92.6 ft. 10YR 4/6 0 s. ml Z M__ ad . s Depth to
limiting NOTES:
factor
90 in. r-r If trench s were cited close to B6 'n orde to S'te t enl'h
Remarks: in .8GPD/ft2 sang strata; per ILHR 83.13(6), more than 18" r
Boring # e ,
7 1 -14 10YR 2/2 organic loam lfsbk mfr. gs 2f .4 1.5
2 4-3 10YR 3/3 loam 2fsbk mfr. 1IR 1Vf -9 '_6
Ground 3 2-5 10YR 4/4 ra
elev.
,_3 0 4 0-9 l 0YR 5/6 m d. s. 0, s t dl .7 8
94
ft.
Depth to
limiting
factor
in. Remarks:
CST Name (Please Print) Signature Telephone No.
Robert Ulbricht 715-386-8185
Address Date CST Number
June 22 1996
PROPERTY OWNER J . &B . Knorn SOIL DESCRIPTION REPORT
Page __2_ of 3
PARCEL LDI Lit 3, CSM 525427, Vol.10, pg.2872
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots 2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
8 ,
1 -13 10YR 2/2 loam lfsbk mfr. gs 2f .4 .5
2 3-2_ 10YR 3/3 loam lfsbk mfr. cs if .4 -.5
Ground 3 2-5 10YR 4/4 Rocky med.s 0,sg. dl cs / .7 .8
elev.
96-1-0t. 4 0-9 10YR 5/4 gravelly
.7 .8
Depth to
limiting
faagr
5 in.
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
in.
Remarks:
Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
in. Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
in.
Remarks:
SBDW-8330 (R. 08/95)
N0. co 7 3`d Y•
0
Pg.3 of 3
LOT 3
SCALE: 111=30'
• = Backhoe Pits
p = Existing Grade Elevations
~ o
Suggested trench system ~i
elevations: W
High trench 91.30"
Low trench 90.80'
I Bldg. sewer must
97.5 be 95.0' or highe .
a► to provide for
33 E--'-'gravity flow to
tested area.
I
ao 3q' NO low areeaa
/ silty soi s
r I
I
BIG
,
fly ~ So. Lod
r,
Y
B.M. Found: top of surveyor's 300,
1" IP at S.W. lot corner. \
ELEVATION:100.0' 1`'
FILED
JAN 2 5 1995 ►
KATHLEEN H. WALSM
Register of Deeds 1Q
Z St. Croix co., vVt
525427
CERTIFIED SURVEY MAP
DARYL JONES,'etal.
Part of the SE 114 of the SE 114 and the NE 114 of the SE 114 of Section 20, T 29 N,
R 18 W, Town of Warren,'-St. Croix County, Wisconsin. a
h
UNPL A TT ED LANDS
O Indicates 1" x 24" iron pipe weighing
N 89 • 14' 46 "E 389. 00' - ~b
1.13 lbs./lin. ft. set.
6.7
O 312.26 ' i
O i ~ o2i O
I
Owner's Address: N L O T Z o 0 0
1126 80TH AVE. y !u 2.232 ACRES C ( N
Roberts, WI 54023 QI ZI 10 0 97, 242 so. Fr. i N W
J O 2.019 ACRES EXC. ROAD N N ;
JI R. 0. W. I ti h
Z 00 87,951 SO. FT. I I a
J Z 311. 41' I 371 1- a j
N 8-9 - 14 ' 46 " E 3189.00' i 0 W V
p ,1 ~ ~ O h W
1' I
e
N 89• 14' 46 "E 389.00' b b O
h
309 311. 19'
1 7. e Q Q
P~ E I • ( Z
~ ~1 / A m z Q
3 I °t . W J
LOT 3 I • I :t
QI
t'A I tu0 M N 14
S 81 06,16"" p 2.875 ACRES I a N of lu I W
154-41'
N 121, 247 s0. Fr. I M to
C I
D O ~
M 2.592 ACRES EXC. ROA O
Q
N ~
R. 0. W. I O o I a J
M 1/2, 900 50. Fr. I O
I. 1 2 O N
Z
L0 T 5 W N89 /4'46"E 389.00' I
Q) q
"q 350.10- .9
V B O
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Q N 'O S E COR. SEC. 20, r 29 N, R /8 W,
/COUNTY SURVEYOR'S MON.1 -S ``'ty~~~~~~~~,i.(IPY undo
1 o This instrument drafted by A' *41
Laurence W. Murphy
sCO`/ +
STC-105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER r- S
MAU.ING ADDRESS
PROPERTY ADDRESS
,p (location of septic system) Please obtain from the Planning Dept.
CITY/STATE VC 6 ' ~C' ~l s
PROPERTY LOCATION y 1/4, C, 1/4, Section , T__v) N-R_/cP W
TOWN OF /)4 Y' M , ST. CROIX COUNTY, WI
SUBDIVISION d~rr~ , LOT NUMBER _
CERTIFIEDSURVEY MAP S Y~~ VOLUME, PAGE LOT NUMBER-
Improper use and maintenance of your septic system could result in its premature failure to handle
wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed
by licensed septic tank pumper.. What you put into the system can affect the function of the septic tank
as a treatment stage in the waste dis system.
St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost
of replacemen"f a failing system, which was in operation prior to July 1, 1978. St. Croix County
accepted this program in August of 1980, with the requirement that owners of all new systems agree to
keep their system properly maintained.
The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner
and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1)
the on-site wastewater disposal system is in proper operating condition and (2) after inspection and
pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum.
I/We, the undersigned have read the above requirements and agree to maintain the private sewage
disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR.
Certification stating that your septic has been maintained must be completed and returned to the St. Croix
County Zoning Officer within 30 days of the three year expiration date.
SIGNED: ALa") Ltw
DATE: '
St. Croix County Zoning Office
Government Center
1101 Carmichael Road
Hudson, WI 54016 11/93
S T C - 100
This application form is to be completed in full and signed by the
owner(s) of the property being developed. Any inadequacies will
only result in delays of the permit issuance. Should this
development be intended for resale by owner/contractor, (spec
house), then a second form should be retained and completed when
the property is sold and submitted to this office with the
appropriate deed recording.
r-
Owner of property ~~~LyL f ~ P76 Y' Y)
Location of property 1/4 1/4, Section 9 0 T 2 N-R W
Towns ip (JO, U,Veyi Mailing address o Gt
ew
Address of site c7 0) ,f G 1
Subdivision name N4 Lot no. _
Other homes on property? Yes No
Previous owner of property 6, -0 JG
Total size of property
Total size of parcel
Date parcel was created
Are all corners and lot lines identifiable? _ Yes No
Is this property being developed for (spec house)? Yes ~~C No
Volume -IA' and Page Number as recorded with the Register
of Deeds.
INCLUDE WITH THIS APPLICATION THE FOLLOWING:
A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE
NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. In addition, a
certified survey, if available, would be helpful so as to avoid
delays of the reviewing process. If the deed description
references to a Certified Survey Map, the Certified Survey Map
shall also be required.
PROPERTY OWNER CERTIFICATION
I (we) certify that all statements on this form are true to the
best of my (our) knowledge that I (we) am (are) the owner(s) of the
property described in this information form, by virtue of a
warranty deed recorded in /~~5w ice of the County Register of
Deeds as Document No. , and that I (we) presently
own the proposed site for the sewage disposal system or I (we)
obtained an easement, to run the above described property, for the
construction of said system, and the same has been duly recorded in
the off' of the County Register of Deeds as Document No.
Sig ature of Applicant Co-Applicant
6) Y~ -
Date of S ' gnature natA nf C i rrnatiira
545541 STATE BAR OF WISCONSIN FORM 2 - 1982
WARRANTY DEED
DOCUMENT NO. poi. 1185 PAGE 161 REGISTER'S OFFICE
Holly A. Jones, a/k/a Holly Jones, ST.CROIXCTY.,WI
a~~t~Aec«d
a married person, JUN 19 1996
conveys and warrants to James Knorn and Barbara Knorn, at ~ 9 20 A
husband and wife, as survivorship marital
property,, Register of Deeds
THIS SPACE RESERVED FOR RECORDING DATA
r
NAME AND . RN ADDRES
the following described real estate in S t . Croix County, EQUITY TITLE SERVICES
State of Wisconsin: 400 SOUTH SECOND STREET
HUDSON, WI 54016
T 6-rs A /697ot
~I~ER
042-1057-40
PARCEL IDENTIFICATION NUMBER
Part of the SE1/4 of the SE1/4 and the NE1/4 of the SE1/4 of
Section 20, T29N, R18W, Town of Warren, St. Croix County,
Wisconsin, being more fully described as follows: Lot 3 of the
Certified Survey Map recorded in Vol. "10", page 2872, of
the Certified Survey Maps, as Document No. 525427.
This is not homestead property.
XiKX (is not)
Exception to warranties: Easements, restrictions and rights-of-way of record,
if any.
Dated this 14th day of June A.D., 19 96
(SEAL) (SEAL)
* Holl A. nes, a/k/a Holly Jones
(SEAL) (SEAL)
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) State of Wisconsin,
ss.
St. Croix County.